Refugees and migrants: overexposed yet unseen
Authors: None The Lancet Global Health
Journal: The Lancet Global Health (2022)

Next month, members of the UK Conservative party will vote on who should succeed Boris Johnson as party leader and, by default, as the country's next Prime Minister. The two remaining candidates—Rishi Sunak and Liz Truss—have fought an increasingly acrimonious battle, yet both seem to agree on one point: Britain has a serious problem with refugees and migrants. Both have promised to uphold, or even extend, a widely-criticised bilateral agreement to deport certain people seeking asylum in the UK to Rwanda. And both support the Brexit process, which ended the automatic right of citizens of the European Union to live and work in the UK (and vice versa). Yet as the latest UK census data show, net international migration has been declining since 2016. Furthermore, as the UCL–Lancet Commission on migration and health pointed out, evidence shows an “overwhelming consensus” that migrants make a positive economic contribution to both host nations and the countries of origin (by way of remittances, for example). The Commission also dispelled the myths—in high-income countries at least—that migrants are a burden on services and have unsustainably high fertility rates. It is undoubtedly the case, however, that the world is becoming ever more mobile and that refugees and migrants are becoming an increasingly large demographic. Earlier this year, UNHCR's Global Trends report revealed that the number of people forcibly displaced by conflict, violence, human rights violations, and persecution had surpassed 100 million for the first time on record. New conflicts in Ukraine and Ethiopia, as well as political upheaval in Afghanistan and Myanmar, were prominently in the news, highlighting the very real threats to many ordinary citizens worldwide. Other ongoing military, climatic, and economic crises continued in the background. And migration, whether forced or not, comes with its own challenges, not least for health. In addition to the sometimes hazardous physical and mental health situations experienced while on the move, migrants and refugees may be confronted with additional barriers to health care, including out-of-pocket expenses, cultural and language differences, discrimination, and fear of deportation. Labour migrants often find themselves in the so-called 3D jobs: those that are dirty, dangerous, or demanding, with little or no social protection or occupational health services. Cramped, poorly ventilated living conditions may exacerbate infectious disease transmission. Health systems must therefore be reoriented to respond to the needs of refugees and migrants, for the benefit of everyone. This is one of the conclusions of the first ever WHO World Report on the Health of Refugees and Migrants, published last month. Such a reorientation aligns with WHO’S drive towards making primary-health care the foundation of universal health coverage, its focus on health promotion and disease prevention, and the imperative to take a whole-of-government and whole-of-society approach to solutions. These strategies make for responsive and resilient health systems—ie, those that can adapt to changing population structures and withstand the direct and indirect shocks of future pandemics and other emergencies. Another of the more striking conclusions of the World Report was that the global health community is failing abysmally in its efforts to monitor the health of refugees and migrants, as required by Sustainable Development Goal (SDG) target 17.18. The report authors initially set out to do a review of international survey data on health and migration, but the only conclusions they were able draw were that the data “do not yet permit accurate measurement of the progress made for refugees and migrants towards achieving the SDG targets”. The invisibility of this burgeoning demographic group at the data monitoring level contrasts regrettably with the exposure of refugees and migrants within nationalistic policy-making. It also severely curtails our ability to evaluate the impact of any migrant-inclusive policies that are introduced. The World Report notes that successful migrant-inclusive policies do exist—such as Jordan's impressive COVID-19 refugee vaccination plan—but that there is a lack of political commitment to implement them. As long as populist political candidates use refugees and migrants as inflammatory campaign fodder, the health and wellbeing of all of us will suffer. Migrants and displaced people: intentionally endangered and inconsistently visibleThe Lancet Global Health Editorial published in the September 2022 issue1 reiterates some of the challenges faced by migrants and refugees. Rather than neutral codifiers of nationality and relevant frameworks for legal protection, these terms are invariably manipulated for political gain. Diverse groups of people are also homogenised by these terms, which serves to disguise racialised and geopolitical inconsistences in the treatment of certain subgroups within these categories. Full-Text PDF Open Access